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目的利用血管内超声(IVUS)探讨冠状动脉易损斑块与血中单核细胞趋化活性的相关性。方法对40例稳定型心绞痛(SAP)和40例不稳定型心绞痛(UAP)患者分别进行冠脉造影(CAG)和血管内超声(IVUS)检查。应用IVUS分别观察比较冠状动脉内斑块的性质,同时测量冠脉病变部位及其参考部位的血管外弹力膜面积(EEMA)、管腔面积(LA)、斑块面积(PA)及斑块负荷(PB%),并计算斑块的偏心指数(EI)及血管的重构指数(RI)。应用Transw ell小室检测两组患者血液中单核细胞的趋化活性。相关性分析IVUS检测指标与单核细胞活性的相关性。结果 IVUS检测显示,UAP组主要为脂质性斑块,约占50%(46/92),而SAP组主要为纤维性斑块,约占55%(46/83),脂质斑块仅占17%(14/83)。与SAP组比较,UAP组斑块负荷和血管重构指数显著增高(P均<0.01)。与SAP组的斑块相比较,UAP组的斑块具有较大的偏心性(P<0.05),不稳定斑块呈明显的正性重构,约占68%(27/40),而稳定斑块主要表现为负性重构,约占75%(30/40)。UAP组单核细胞趋化活性明显增强,单核细胞移动数量明显多于SAP组,差异有统计学意义(P<0.01)。相关性分析显示,IVUS测值PB与单核细胞趋化活性呈显著正相关(γ=0.52,P<0.01)。结论 IVUS能够准确地识别AS易损斑块。单核细胞趋化活性反映了粥样斑块的稳定性。
Objective To explore the relationship between the chemotactic activity of monocytes in vulnerable plaque of coronary artery and blood using intravascular ultrasound (IVUS). Methods 40 patients with stable angina pectoris (SAP) and 40 patients with unstable angina pectoris (UAP) underwent coronary angiography (CAG) and intravascular ultrasound (IVUS). IVUS were used to observe the nature of intracoronary plaque. The areas of extracorporeal elastic membrane (EEMA), luminal area (LA), plaque area (PA) and plaque burden (PB%), and the plaque eccentric index (EI) and vascular remodeling index (RI) were calculated. Transwell cells were used to measure the chemotactic activity of monocytes in the blood of both groups. Correlation analysis of the correlation between IVUS detection index and monocyte activity. Results The results of IVUS showed that the UAP group was predominantly lipidated, accounting for about 50% (46/92), while the SAP group was predominantly fibrous (55%, 46/83). The lipid plaque Accounting for 17% (14/83). Compared with SAP group, the plaque load and vascular remodeling index in UAP group were significantly increased (all P <0.01). Compared with the SAP group, the plaques in the UAP group had a greater eccentricity (P <0.05), and the unstable plaques showed a significant positive remodeling, accounting for 68% (27/40), while the stable Plaques showed mainly negative remodeling, accounting for about 75% (30/40). UAP group monocyte chemotactic activity was significantly enhanced, the number of mononuclear cells was significantly more than the SAP group, the difference was statistically significant (P <0.01). Correlation analysis showed that there was a significant positive correlation between IVUS measured PB and monocyte chemotactic activity (γ = 0.52, P <0.01). Conclusion IVUS can accurately identify vulnerable plaque AS. Monocyte chemotactic activity reflects the stability of atherosclerotic plaques.